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Liu W, Bretz F, Böhning D, Holt RIG, Han Y, Böhning W, Guha N, Cowan DA. Combined statistical decision limits based on two GH-2000 scores for the detection of growth hormone misuse. Stat Methods Med Res 2022; 31:1439-1448. [PMID: 35611962 PMCID: PMC9315177 DOI: 10.1177/09622802221093730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The growth hormone-2000 biomarker method, based on the measurements of
insulin-like growth factor-I and the amino-terminal pro-peptide of type III
collagen, has been developed as a powerful technique for the detection of growth
hormone misuse by athletes. Insulin-like growth factor-I and amino-terminal
pro-peptide of type III collagen are combined in gender-specific formulas to
create the growth hormone-2000 score, which is used to determine whether growth
hormone has been administered. To comply with World Anti-Doping Agency
regulations, each analyte must be measured by two methods. Insulin-like growth
factor-I and amino-terminal pro-peptide of type III collagen can be measured by
a number of approved methods, each leading to its own growth hormone-2000 score.
Single decision limits for each growth hormone-2000 score have been introduced
and developed by Bassett, Erotokritou-Mulligan, Holt, Böhning and their
co-authors in a series of papers. These have been incorporated into the
guidelines of the World Anti-Doping Agency. A joint decision limit was
constructed based on the sample correlation between the two growth hormone-2000
scores generated from an available sample to increase the sensitivity of the
biomarker method. This paper takes this idea further into a fully developed
statistical approach. It constructs combined decision limits when two growth
hormone-2000 scores from different assay combinations are used to decide whether
an athlete has been misusing growth hormone. The combined decision limits are
directly related to tolerance regions and constructed using a Bayesian approach.
It is also shown to have highly satisfactory frequentist properties. The new
approach meets the required false-positive rate with a pre-specified level of
certainty.
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Affiliation(s)
- Wei Liu
- Mathematical Sciences & Southampton Statistical Sciences Research Institute, 7423University of Southampton, UK
| | - Frank Bretz
- 111826Novartis Pharma AG, Basel, Switzerland
| | - Dankmar Böhning
- Mathematical Sciences & Southampton Statistical Sciences Research Institute, 7423University of Southampton, UK
| | - Richard I G Holt
- Human Development and Health Academic Unit, Faculty of Medicine, Southampton General Hospital, 7423University of Southampton, UK
| | - Yang Han
- Department of Mathematics, 5292University of Manchester, Manchester, UK
| | - Walailuck Böhning
- Human Development and Health Academic Unit, Faculty of Medicine, Southampton General Hospital, 7423University of Southampton, UK
| | - Nishan Guha
- Chemical Pathology and Metabolic Medicine Department of Clinical Biochemistry, 11269John Radcliffe Hospital, Oxford, UK
| | - David A Cowan
- Department of Analytical and Environmental Sciences, College LondonKing's College London, London, UK
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Narduzzi L, Buisson C, Morvan ML, Marchand A, Audran M, Le Bouc Y, Varlet-Marie E, Ericsson M, Le Bizec B, Dervilly G. Coupling Complete Blood Count and Steroidomics to Track Low Doses Administration of Recombinant Growth Hormone: An Anti-Doping Perspective. Front Mol Biosci 2021; 8:683675. [PMID: 34179089 PMCID: PMC8222787 DOI: 10.3389/fmolb.2021.683675] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/20/2021] [Indexed: 11/23/2022] Open
Abstract
Growth Hormone (GH) under its human recombinant homologue (rhGH), may be abused by athletes to take advantage of its well-known anabolic and lipolytic properties; hence it is prohibited in sports by the World Anti-Doping Agency. Due to the rapid turnover of rhGH, anti-doping screening tests have turned to monitor two endocrine biomarkers (IGF-I and P-III-NP), but unfortunately, they show population-wise variability, limiting the identification rate of rhGH users. Previous studies have evidenced the numerous effects of GH on human physiology, especially in hematopoiesis and steroidogenesis. In this work, aiming to discover novel physiological rhGH biomarkers, we analyzed the complete blood count and the steroidomics profile of healthy, physically active, young males treated either with EPO + rhGH or EPO + placebo. The time-trends of these two physiological routes have been analyzed through geometric trajectory analysis (GTA) and OPLS-DA. Individuals supplemented with micro-doses of rhGH exhibited different leukopoietic and steroidal profiles compared to the control population, suggesting a role of the rhGH in both pathways. In the article, hypotheses on the observed differences are discussed according to the most recent literature and compared to results in animal models. The use of leukopoietic and steroidal biomarkers together with endocrine biomarkers (IGF-1 and P-III-NP) allows to correctly classify over 98% of samples with no false positives, miss-classifying only one single sample (false negative) over a total of 56; a promising result, if compared to the current rhGH detection strategies.
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Affiliation(s)
- Luca Narduzzi
- Laboratoire D’Etude des Résidus et Contaminants Dans Les Aliments (LABERCA), Oniris, INRΑe, Nantes -44307, France
| | - Corinne Buisson
- Département des Analyzes, Agence Française de Lutte Contre le Dopage (AFLD), Châtenay-Malabry, French Anti-Doping Agency, Paris, France
| | - Marie-Line Morvan
- Laboratoire D’Etude des Résidus et Contaminants Dans Les Aliments (LABERCA), Oniris, INRΑe, Nantes -44307, France
| | - Alexandre Marchand
- Département des Analyzes, Agence Française de Lutte Contre le Dopage (AFLD), Châtenay-Malabry, French Anti-Doping Agency, Paris, France
| | - Michel Audran
- Département des Analyzes, Agence Française de Lutte Contre le Dopage (AFLD), Châtenay-Malabry, French Anti-Doping Agency, Paris, France
| | - Yves Le Bouc
- Sorbonne Université, INSERM, Centre de Recherche St-Antoine (CRSA), Paris, France
| | - Emmanuelle Varlet-Marie
- Institut des Biomolécules Max Mousseron (IBMM), Centre Hospitalier Universitaire de Montpellier, Montpellie, France
| | - Magnus Ericsson
- Département des Analyzes, Agence Française de Lutte Contre le Dopage (AFLD), Châtenay-Malabry, French Anti-Doping Agency, Paris, France
| | - Bruno Le Bizec
- Laboratoire D’Etude des Résidus et Contaminants Dans Les Aliments (LABERCA), Oniris, INRΑe, Nantes -44307, France
| | - Gaud Dervilly
- Laboratoire D’Etude des Résidus et Contaminants Dans Les Aliments (LABERCA), Oniris, INRΑe, Nantes -44307, France
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Yamamoto M, Pinto-Sanchez MI, Bercik P, Britz-McKibbin P. Metabolomics reveals elevated urinary excretion of collagen degradation and epithelial cell turnover products in irritable bowel syndrome patients. Metabolomics 2019; 15:82. [PMID: 31111238 DOI: 10.1007/s11306-019-1543-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 05/09/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Irritable bowel syndrome (IBS), the most commonly diagnosed functional gastrointestinal (GI) disorder in developed countries, is characterized by chronic abdominal pain, and altered bowel habits. OBJECTIVES Accurate and timely diagnosis is challenging as it relies on symptoms and an evolving set of exclusion criteria to distinguish it from other related GI disorders reflecting a complex etiology that remains poorly understood. Herein, nontargeted metabolite profiling of repeat urine specimens collected from a cohort of IBS patients (n = 42) was compared to healthy controls (n = 20) to gain insights into the underlying pathophysiology. METHODS An integrated data workflow for characterization of the urine metabolome with stringent quality control was developed to authenticate reliably measured (CV < 30%) and frequently detected (> 75%) metabolites using multisegment injection-capillary electrophoresis-mass spectrometry. Complementary statistical methods were then used to rank differentially excreted urinary metabolites after normalization to osmolality that were subsequently identified by high resolution tandem mass spectrometry and their electrophoretic migration behavior. RESULTS Our work revealed ten consistently elevated urinary metabolites in repeat samples collected from IBS patients at two different time points (q < 0.05 after age and Benjamini-Hochberg/FDR adjustment), which were associated with greater collagen degradation and intestinal mucosal turn-over processes likely due to low-grade inflammation. IBS-specific metabolites identified in urine included a series of hydroxylysine metabolites (O-glycosylgalactosyl-hydroxylysine, O-galactosyl-hydroxylysine, lysine), mannopyranosy-L-tryptophan, imidazole propionate, glutamine, serine, ornithine, dimethylglycine and dimethylguanosine. A major limitation in this retrospective case-control study was significant co-morbidity of IBS patients with other illnesses, including depression and prescribed medications as compared to healthy controls. CONCLUSION This work provides new mechanistic insights into the pathophysiology of IBS while also offering a convenient way to monitor patient disease progression and treatment responses to therapy based on a panel of urinary metabolites that avoids invasive blood sampling, colonoscopy and/or tissue biopsies.
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Affiliation(s)
- Mai Yamamoto
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, ON, L8S 4M1, Canada
| | | | - Premysl Bercik
- Farncombe Family Digestive Health Institute, McMaster University, Hamilton, Canada
| | - Philip Britz-McKibbin
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, ON, L8S 4M1, Canada.
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Böhning D, Böhning W, Guha N, Cowan DA, Bartlett C, Sönksen PH, Holt RIG. A correction to the age-adjustment of the GH-2000 score used in the detection of growth hormone misuse. BMC Res Notes 2018; 11:650. [PMID: 30185229 PMCID: PMC6125940 DOI: 10.1186/s13104-018-3741-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 08/28/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The GH-2000 biomarker test has been introduced by the World Anti-Doping Agency as a method of detecting growth hormone misuse in professional sport. The test involves the measurement insulin-like growth factor-I and the amino-terminal pro-peptide of type III collagen (P-III-NP) which increase in a dose-dependent manner in response to GH. These measurements are combined in sex specific formulae that include an age adjustment. The original age adjustment overcorrects the effect of age in male athletes and could potentially place older men at a disadvantage. The purpose of this note is to investigate the performance of a previously suggested correction term in two new and larger data sets. RESULTS The GH-2000 score was calculated for 7307 samples obtained from 15 accredited WADA laboratories in 2017 and 3916 samples measured at Drug Control Centre, King's College London, UK between 2013 and 2017. The GH-2000 scores were investigated for positive age effects using standard regression modelling. As previously, all analyses confirmed a positive age effect. Applying the earlier suggested correction term of 0.032 × age showed a significant over-correction leading to a negative association of the GH-2000 score with age. We now suggest a smaller age correction of 0.020 × age, which corresponds to the smallest effect found in the earlier studies.
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Affiliation(s)
- Dankmar Böhning
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, SO17 1BJ, UK.
| | - Walailuck Böhning
- Human Development and Health Academic Unit, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
| | - Nishan Guha
- Nuffield Division of Clinical Laboratory Sciences, UK Department of Clinical Biochemistry Level 4, University of Oxford, John Radcliffe Hospital Headley Way, Headington, Oxford, OX3 9DU, UK
| | - David A Cowan
- Department of Pharmacy and Forensic Science, Drug Control Centre, King's College London, 150 Stamford Street, London, SE1 9NH, UK
| | - Christiaan Bartlett
- Department of Pharmacy and Forensic Science, Drug Control Centre, King's College London, 150 Stamford Street, London, SE1 9NH, UK
| | - Peter H Sönksen
- Human Development and Health Academic Unit, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
| | - Richard I G Holt
- Human Development and Health Academic Unit, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
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Böhning D, Liu W, Holt RIG, Böhning W, Guha N, Sönksen P, Cowan D, Liang T. Exact statistical calculation of the uncertainty term in the decision limits of the GH-2000 score for growth hormone misuse (doping) detection. Stat Methods Med Res 2017; 28:928-936. [DOI: 10.1177/0962280217739452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The GH-2000 score has been developed as a powerful and unique technique for the detection of growth hormone misuse by sportsmen and women. The score depends upon the measurement of two growth hormone sensitive markers, insulin-like growth factor-I and the amino-terminal pro-peptide of type III collagen. It also includes a term to adjust for the age of the athlete. Decision limits for the GH-2000 score have been developed and are incorporated into the guidelines of the World Anti-Doping Agency. These decision limits are derived by setting a 1 in 10,000 false-positive rate rule. As these decision limits are estimated from samples of GH-2000 scores, they carry uncertainty. In previous work, this uncertainty has been addressed by establishing an upper 95% confidence interval for the true decision limits based on a normal approximation which has been shown to be appropriate if sample sizes are large (such as 1000 and above). Here, we show that these approximations, whether reasonable or not, can be entirely avoided by developing an upper 95% confidence interval for the true decision limits using an approach based upon the t-distribution. While there are considerable differences for smaller sample sizes, these become negligible when the sample size is large such as 1000 and above.
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Affiliation(s)
- Dankmar Böhning
- Mathematical Sciences and Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Wei Liu
- Mathematical Sciences and Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Richard IG Holt
- Human Development and Health Academic Unit, Faculty of Medicine, The Institute of Developmental Sciences, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Walailuck Böhning
- Human Development and Health Academic Unit, Faculty of Medicine, The Institute of Developmental Sciences, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Nishan Guha
- Chemical Pathology and Metabolic Medicine, Department of Clinical Biochemistry, John Radcliffe Hospital, Oxford, UK
| | - Peter Sönksen
- Human Development and Health Academic Unit, Faculty of Medicine, The Institute of Developmental Sciences, Southampton General Hospital, University of Southampton, Southampton, UK
| | - David Cowan
- Drug Control Centre, Department of Pharmacy and Forensic Science, King’s College London, London, UK
| | - Tianyi Liang
- Mathematical Sciences and Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
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Böhning D, Böhning W, Guha N, Cowan DA, Sönksen PH, Holt RIG. Erratum to: Statistical methodology for age-adjustment of the GH-2000 score detecting growth hormone misuse. BMC Med Res Methodol 2016; 16:164. [PMID: 27894262 PMCID: PMC5126816 DOI: 10.1186/s12874-016-0262-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Dankmar Böhning
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, SO17 1BJ, UK.
| | - Walailuck Böhning
- Human Development and Health Academic Unit, University of Southampton Faculty of Medicine, IDS Building (MP887), Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Nishan Guha
- Human Development and Health Academic Unit, University of Southampton Faculty of Medicine, IDS Building (MP887), Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.,Nuffield Division of Clinical Laboratory Sciences, UK Department of Clinical Biochemistry Level 4, University of Oxford, John Radcliffe Hospital Headley Way, Headington, Oxford, OX3 9DU, UK
| | - David A Cowan
- Department of Pharmacy and Forensic Science, Drug Control Centre, King's College London, 150 Stamford Street, London, SE1 9NH, UK
| | - Peter H Sönksen
- Human Development and Health Academic Unit, University of Southampton Faculty of Medicine, IDS Building (MP887), Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Richard I G Holt
- Human Development and Health Academic Unit, University of Southampton Faculty of Medicine, IDS Building (MP887), Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
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